| NPI | 1316459480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018175) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2024-03-05 |